Problems have been persistent in California Workers’ Compensation over the past several years – everything from capping schemes to extended service delays have posed challenges to a program designed to assist citizens in scheduling and receiving treatment for injuries sustained in the workplace. But when the agency charged with regulating the industry is being questioned, then things become a tad bit more complicated. Evidence obtained suggests that the Department of Industrial Relations (DIR) Division of Workers’ Compensation (DWC), the Independent Bill Review (IBR), and certain insurance carriers have been meeting behind closed doors – resulting in the creation and implementation of “underground regulations” that have affected the QME program negatively.


It was in April 2018 that a settlement was reached between the DWC and eight doctors that accused the division, and former director Christine Baker, of crafting and implementing questionable regulations, which, in turn, forced the agency to abandon four particular rules that made it possible for them to deny reappointments and avoid administrative hearings and responsibilities without any reason or prior notice. The regulations were successfully proven in court to have been adapted incorrectly, confirming the need for a change in the way the DWC has been operating. This was just the latest in a series of cases that saw over 400 QME’s file lawsuits against the DIR for similar actions that may have deprived them of ideal regulatory conditions. To their credit, the DIR has started to adjust accordingly – but there is still plenty that needs to be done in order to witness a full recovery.


Due to the DWC’s blunders, the number of QME’s in active service has fallen off dramatically, leaving long backlogs of service and hindering the ability of workers’ comp claimants to receive treatment. Furthermore, the DIR is also being questioned for neglecting the QME Fee Schedule since 2006, another action that has contributed to the recent lack of physicians interested in practicing as medical evaluators. Lawmakers in California, led by 48th District Assemblywoman Blanca Rubio, are requesting for further investigation into the matter with the intention of finding solutions to these issues in the hope that efficiency and reliability can be restored to the state’s Workers’ Compensation industry.


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